FIRST CHRISTIAN CHURCH (DISCIPLES OF CHRIST)
1200 Third Street Moundsville, WV 26041
PERMISSION FORM
Mr. Chuck Morrow – Youth Director Representative of the First Christian Church of Moundsville, WV has
my permission to take my child/children (Print):
__________________________________________________________________________________________
__________________________________________________________________________________________
From the Church premises on the date of Friday February 10th, to attend Christian Church (Disciples of Christ)
WV, Midwinter Retreat at Cedar Lakes Conference Center - Ripley, WV.
First Christian Church will not be legally responsible for any liability during this period. Expected time of
return will be: Sunday Afternoon February 12th. We will make a Call to the number listed below to
inform you that we are leaving and on our way back. Time of travel will be around 2 ½ - 3 hours. If you
have any questions, please contact: Chuck Morrow, Youth Director First Christian Church Moundsville WV
at (304) 830-2617- Cell Phone.
Parent/Legal Guardian Name (Print): ________________________________________________________
Parent/Guardian contact number in case of emergency: __________________________________________
Parent/Legal Guardian Signature: _____________________________________ Date: _________________
FIRST CHRISTIAN CHURCH (DISCIPLES OF CHRIST)
1200 Third Street Moundsville, WV 26041